Researchers have demonstrated that in human infants, prenatal alcohol exposure (PAE) is associated with problems with state and autonomic regulation, increased post-stress cortisol levels, higher levels of irritability, increased negative affect, and increased level of activity. These findings suggest that PAE can profoundly compromise an infant's capacity for self-regulation, which in turn may place them well on course for a negative developmental trajectory. Deficits in self-regulation can confer further vulnerability on the alcohol- exposed infant by compromising early parent-child relationships, impairing a child's ability to manage stressful situations, interfering with learning and mastery of developmentally appropriate tasks, and potentially impacting early brain development. Strikingly, there are currently no evidence-based interventions designed for infants and toddlers with PAE or who have been diagnosed with a Fetal Alcohol Spectrum Disorder (FASD). Given the persistence and severity of many alcohol-induced deficits, and the extremely poor long-term outcomes of individuals affected by PAE, especially for those whom do not receive the benefit or early intervention or a stable, nurturing caregiving environment, the need to develop effective treatments for infants and toddlers in this high-risk population is urgent. Early intervention aimed at enhancing these children's capacity to regulate their emotions and behavior would potentially represent a major advance in efforts to reduce the long-term adverse outcomes for these children. Moreover, as the consequences of prenatal alcohol exposure are likely to reverberate well beyond those experienced directly by the alcohol-exposed individual, interventions that operate at multiple levels of the family system are likely to be the most effective. Thus the proposed study entails an innovative multi-component intervention to foster self-regulation in infants and toddlers in foster or adoptive care with a history of PAE or a diagnosis of an FASD. Two components, a parent education and advocacy module and an attachment-based parent group, will focus on improving parents'knowledge and skills that will enhance their ability to respond to their children in ways that support the development of self- regulation. A third component, a music-based parent-child play group, will serve to promote positive parent- child interactions and is based on findings that exposure to singing and music can enhance self-regulation in young children. Improving parental sensitivity, increasing parental commitment, decreasing parental stress, enhancing the quality of the parent-child relationship, and ultimately, fostering the child's capacity for self- regulation may all play a critical role in circumventing a cascade of negative developmental outcomes associated with PAE. Furthermore, the aim of this multi-component to address a core deficit-impairment in self-regulation--would likely have relevant applications for other high-risk infants and toddlers presenting with other neurodevelopmental disorders. PUBLIC HEALTH RELEVANCE: Children with prenatal alcohol exposure often experience emotional and behavioral problems throughout life. The goal of this study is to test an intervention designed to help infants and toddlers learn skills that will help them manage their emotions and behaviors and teach parents how to support their children's development of those skills. Teaching children with prenatal alcohol exposure these skills may help reduce their risk for negative long-term outcomes, such as delinquency, school failure, and mental health problems.